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OS II > Intro to Counterstrain > Flashcards

Intro to Counterstrain Flashcards

1
Q

What is counterstrain?

A

dysfunction which inhibited by apply a position of mild strain in direction exactly opposite to that of the false strain effect

use specific point of tenderness related to this dysfunction followed by specific directed positioning to achieve the desire

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2
Q

Posterior Tender points

A

PT3-5

PT6-UPL5

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3
Q

What invented counterstrain?

A

Lawrence Jones DO
1955

discovered posterior tender points

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4
Q

Trigger point vs Tender point

A

Trigger point

  • pt present with characteristic pain pattern
  • located in muscle tissue
  • locally tender
  • elicits jump sign and radiating pain pattern
  • taut band of tissue
  • twitch response with snapping palpation
  • demographia of skin over point

Tender point

  • no pain pattern
  • located in muscles, tendons, ligaments, fascia,
  • locally tender
  • jump sign but NO radiating patterin
  • taut band not present
  • twitch response not present
  • demographia
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5
Q

Treatment for trigger point and tender point

A

Trigger point

  • spray and stretch
  • trigger point injection

Tender point
- spontaneous release by positioning (counterstrain)

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6
Q

Trauma Physiology

A

trauma

1) changes in myofascial tissue at microscopic and biochemical leve
2) damage to myofibrils and microcirculation

Nociceptive information to CNS

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7
Q

Counterstrain Theories

A

1) Nociceptive model
2) proprioceptive model
3) four phases of counterstrain

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8
Q

Nociceptive Model

  • mechanism of action
  • example (ankle sprain)
A

a tissue is strained recruiting nociceptors within that tissue (muscle, tendon, ligament)

Reflexive contraction of affected tissues

contraction of affected tissue become neutral

Ankle

  • reflexive contraction occurs at lateral ankle
  • contraction of the lateral ankle becomes the new neutral
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9
Q

Proprioception Model

  • mechanism of action
  • example- whip lash
A

maintain tone for a period after the stimulus has ended

Muscle spindle fiber
- excessively rapid stretch of primary spindle cell can induce a protective contraction in extrafusal fibers related to it, which can maintain tone for a period after the stimulus has ended

Muscle is strained (agonist)-> antagonist muscle is shortened ( turns down spindling fire rate) => CNS turns up gain for antagonist gamma system
-> antagonist contraction become “neutral”

Whiplash

  • posterior cervical muscles are strained
  • anterior cervical muscles shorteneed CNS turns up gain for antagonist gamma system
  • antagonist contraction becomes the new neutral
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10
Q

Counterstrain Theory: Nociceptor

A
  • nociceptor recruitment
  • agonist (affected tissue) shortened
  • agonist tissue shortening
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11
Q

Counterstrain Theory:

proprioceptor

A

antagonist muscle shortened

antagonist muscle shortening becomes new neutral

gamma loop becomes new neutral

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12
Q

nociceptor vs proprioceptor models

A

local constriction of muscles causes decreased circulation, causing localized edema and back up products of metabolism

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13
Q

Phases of counterstrain

A

1) relaxation
2) reset of spindle fibers and nociceptors
3) washout
4) slow return to neutral

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14
Q

Phase of Counterstrain: relaxation

A

shortened the affected tissue in 3 planes

  1. flexion/extension
  2. sidebending
  3. rotation
  4. sometimes traction or compression

rapid reduction in noiceptive input

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15
Q

Phase of Counterstrain: spindle reset

A

primary endings of muscle spindle stretch receptors (annulospiral)

  • length
  • rate of change in length of muscle (dynamic)

secondary endings of muscle spindle stretch receptors ( flower spray)

  • length
  • not dynamic changes (static)
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16
Q

Phase of Counterstrain: Washout

A

increased muscular tone inhibits blood flow which causes buildup of waste products

metabolic washout begins at 10-15 seconds after optimal position achieved

peak washout- 1 minute

17
Q

Phase of Counterstrain: slow return to neutral

A

rapid return could reactivate spindle cell activity

muscle spindles remain somewhat facilitated for up to 24 hours after treatment
- remind patients to take it easy for next day after treatment

18
Q

Counterstrain Treatment steps (7)

A
  1. Find significant tenderpoint
  2. establish a tenderness scale
  3. monitor tender point throughout treatment
  4. place patient in a position of optimal comfort
  5. Maintain position for 90 seconds (120 sec for ribs_
  6. slowly return to neutral
  7. recheck tender point
19
Q
  1. Find significant tenderpoint
A

myofascial structure (ligament, tendon, fascia)

myotomal, dermatomal and scleotomal relationship

scan region of body associated with complaints

people tend to bend around a tend point

20
Q
  1. Establish a tenderness scale
A

scale from 1-10

money and change

visual analog scale

21
Q
  1. Maintain contact throughout treatment
A

palpate changes that occur during treatment

allow for fine-tuning throughout treatment

allow physician and patient to acknowledge treatment success

22
Q
  1. position of optimal comfort
A

start with position considered to be close to optimal ( from text or manual)
- midline position: treatment positions tend to be primarily flexion or extension
- distant from midline positions:
treatment position tend to be primarily sidebending/rotational

Fine tune with small arcs of movement

23
Q
  1. Maintain position for 90 seconds
A 
• 10-15 seconds to begin wash out 
• 1 minute for full wash out 
• Dr. Jones found that holding for 
shorter periods resulted in greater 
return of dysfunction 
• Longer periods resulted in no significant improvement of points
- ribs are held for 120 seconds
24
Q
  1. Retest tender point
A 
• Troubleshooting 
— Did you return to neutral slowly? 
— Did your patient try to 'help"? 
— Is the tender point really a trigger 
point? 
— Is there another/worse tender poi 
that needs to be treated first?
25
Q

Important considerations for counterstrain

A

communication

light contact with tender point throughout treatment

90 sec is long time

SLOWLY return to neutral

no more than 6 tender points per treatment

26
Q

Therapeutic pulse

A

intensity approximates radial pulse

27
Q

position of comfort

A

position at which at least 70% of tenderness is allleviated

28
Q

position of optimal comfort

A

position at which 100% tenderness is alleviated

29
Q

therapeutic reaction

A

situation which occurs in 20-30% of patients treated with counterstrain

30
Q

maverick

A

tender point that does not respond to typical positioning

usually requires opposite position from standard

31
Q

absolute contraindications for counterstrain

A
  1. trauma
  2. severe illness which strict positional restrictions preclude treatment
  3. instability of treatment area (neuro and vascular side effects)
  4. vascular and neurological syndrome
  5. severe degenerative spondolysis
32
Q

Relative contraindications for counterstrain

A
  1. patient cannot voluntarily relax
  2. patient who cannot discern level of pain or its secondary to position
  3. patient who cannot understand the instructions
  4. patients with underlying conditions ( arthiritis, CT disease)
33
Q

Counterstrain benefits

A
  1. passive, indirect technique
  2. can be used in pts with severe osteoporosis, metastatic bone disease and acute injuries
  3. absolute requirement is that patient must be able to willing to relax

OS II (4 decks)

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